Review of "Treating Chronic and Severe Mental Disorders"

This is a well-researched,
carefully edited and very useful technical handbook for clinicians, researchers
and students providing psychological treatment to those individuals with
chronic and severe mental disorders. The editors have successfully drawn
together a fine international team of writers, mostly psychologists and
psychiatrists, to create a text that nevertheless sustains unity of style and
conveys a sense of shared purpose. The chapters nicely balance theory and
research, whilst maintaining an unequivocal focus on practice, and it is hard
to fault.

The explicit focus is on
psychosocial treatment of the 'difficult' mental disorders, i.e. the major
psychoses, substance abuse and personality disorder, and to have extended the
brief, in terms of either the range of disorders or interventions covered,
would have involved sacrifice of depth and detail. A chapter on the treatment
of individuals with dual or multiple diagnoses would have been justified,
however, since we now know that clinicians should expect such clients rather
than view them as exceptions. This could perhaps have been at the expense of
the chapter on 'marital discord and coexisting depression'. The book is divided
into four sections – schizophrenia, mood disorders, substance abuse disorders
and severe personality disorders – comprising four or five short chapters, each
devoted to a specific type of intervention. These include CBT, DBT, family
therapies, social skills training, individual psychotherapy, couples therapy,
and motivational interviewing.

Some of the chapters stand out as
models of clarity and helpfulness. The excellent account of motivational
interviewing, for example, is a precise, step-by-step description, illustrated
by verbatim extracts from sessions, and supported by research studies. The
chapter on dialectical behavior therapy for personality disorder is coauthored
by Marsha Linehan and, as one would expect, is also paradigm of clarity and
completeness (it could have been subtitled "All you ever wanted to know
about DBT but were too afraid to ask"!). I think this is technical writing
at its very best.

Familiarity with the conceptual apparatuses of
contemporary psychiatry and clinical psychology is assumed, along with
knowledge of the etiological factors and clinical features of mental disorders.
The qualities required of the therapist, and the attitudinal and values issues
that therapy raises are mostly set aside, and the emphasis placed strictly on
the clinical application of, and empirical support for, the treatments
employed. In short, this is a 'what to do' and 'how to do it' book! Most of the
chapters draw on case studies and give verbatim accounts of therapy, and there
are some very convenient tabulations of the finer details. The role of
pharmacological treatment is briefly noted in relation to most of the psychosocial
techniques described, although knowledge of pharmacotherapy is assumed. The
evidential support for each treatment is generally presented in a way that
draws attention to the strengths and shortcomings of the research.
Consequently, the referencing for each chapter is copious, appears
comprehensive, and is as recent as can reasonably be expected in a text.

The interventions described refer
to diverse settings, and the text would be useful for psychologists,
psychiatrists and other mental health specialists, working in community or
institutional settings. It would be valuable to novice clinicians developing
their skills under expert supervision, as well as in providing established
clinicians with an evidence base for their practice. In my view, it is the best
text of its kind currently available, and I recommend it without reservation.